Telephonic Consultation-A family physicians perspective

(From a discussion held at a recent IMA meeting in Ahmedabad)

Telephonic consultation is a day-to-day situation that every doctor faces in one way or another. However, most doctors remain confused on how to handle this.

Problems related to telephonic consultation

• Calls can come anytime, anywhere; the doctor may not be prepared or free to take the call.
• Such consultations are time-consuming, as some patients take lots of time to explain the problem.
• The OPD routine gets disturbed, as communication with the next patient in the clinic OPD at that time suffers.
• It is often difficult to recollect patient history on the spot, or doctors simply may not have access to it at the time of the call.
• It is not financially rewarding, as there is no formal concept for it, and most patients do not want to pay for this kind of consultation.
• Serious mistakes can be made in patients hearing the names of prescribed medications, and this can put patients at risk.

Practical aspects and problem areas

• It is a necessary evil.
• Patients prefer to call and talk to a doctor rather than visiting them for minor ailments or giving them updated reports, etc.
• It saves patients time and money.
• Reaching the doctor over the telephone is quite helpful when the patient is travelling or on holidays when the clinic is closed.
• Mobile phones have created havoc, as they are often being misused by patients as an “inquiry service.”

Tips and tricks to manage this

• Discourage telephonic consultation in general. This can never replace the value of an in-clinic consultation.
• Define a stipulated time when patients can call, and the doctor will be relatively free to talk. This can be utilized to share reports or follow up on queries.
• Make telephonic consultation chargeable, either at par with in-clinic charges or more.
• Make the conversation short.
• Restrict telephonic prescriptions to routine drugs only. One should ask the patient to reach a nearby chemist to whom the doctor can directly dictate the drugs; this saves time and avoids errors in interpretation.
• Make a point for the patient to visit the doctor next day if possible.
• Ask your assistant to screen the calls first, this way primary inquiry calls can be avoided.
• Routine calls for sharing of reports or inquiry can be answered by doctor later by calling back at his free time.

Legal angle

To the best of my knowledge:

• You can only consult with patients whom you have seen (in person) in the past.
• The legal responsibility of the doctor is the same over the phone as it is with seeing the patient in person.